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Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System


Hunt, KV and Harding, AM and Taylor, SE and Curtain, C, Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System, Journal of Evaluation in Clinical Practice, 24, (4) pp. 688-694. ISSN 1356-1294 (2018) [Refereed Article]

Copyright Statement

2018 John Wiley & Sons, Ltd.

DOI: doi:10.1111/jep.12944


Rationale, aims, and objectives: Whilst many dose omissions cause no patient harm, inappropriate dose omissions have been associated with increased length of hospital stay, risk of sepsis, and mortality. This study aimed to comprehensively describe the prevalence and nature of omitted doses overall and of high risk medication dose omissions in an organization using an electronic Medication Management System.

Methods: A retrospective cross‐sectional study was undertaken in an Australian tertiary referral health service. All routinely documented electronic inpatient dose administration records from 1st July 2014 to 30th June 2015 were included. Period prevalence and characteristics of dose omissions overall and of high‐risk medication dose omissions were determined.

Results: During the study period, 3.3 million inpatient doses were scheduled for administration, with doses endorsed as "not given" comprising 6.2% of all scheduled doses. Non‐valid dose omissions (medication not available or no justification documented) comprised 1.2% of scheduled doses. Patient refusal accounted for one third of all dose omissions, while for 12% no explanation was provided and 7% were endorsed "medication not available". High‐risk medications accounted for 20% of all dose omissions. One in 20 antimicrobial doses scheduled were omitted, and of these, 17% were due to patient refusal.

Conclusion: The period prevalence of dose omissions in this large study after electronic Medication Management System implementation is similar to that found when paper charts were used. Although most dose omissions appear appropriate, many orders were not given due to patient refusal or with no documented justification. Interventions to minimize unintentional dose omissions are indicated.

Item Details

Item Type:Refereed Article
Keywords:informatics, clinical audit, clinical safety
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Curtain, C (Mr Colin Curtain)
ID Code:127758
Year Published:2018
Web of Science® Times Cited:3
Deposited By:Pharmacy
Deposited On:2018-08-14
Last Modified:2019-01-21

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